Patterns of Care and Survival in Cancer Patients with Brain Metastases Receiving Immune Checkpoint Inhibitors

Abstract

Introduction: Immune checkpoint inhibitors (ICIs) have become a mainstay of treatment for different cancer types. The purpose of this study was to evaluate patterns of care and overall survival (OS) after diagnosis of brain metastases in patients managed with ICI as component of care. Methods: This was a retrospective cohort study. Fifty patients were included (34 with brain metastases at first cancer diagnosis, 16 with metachronous spread). Results: Depending on symptoms, lesion number and size, and other individualized criteria, multidisciplinary tumor (MDT) board discussion resulted in highly individualized treatment sequences. Selected patients received systemic treatment alone. Twenty-four patients (48%) had any stereotactic radiosurgery or neurosurgical resection at some point in time (upfront/salvage). Only 7 patients (14%) were never treated with brain irradiation or neurosurgery. Median OS was 13.0 months. Better Karnofsky performance status, absence of extracranial metastases, and time interval between cancer diagnosis and brain metastases of 0–18 months predicted for improved survival. Treatment sequence was not associated with survival. Patients without extracranial metastases had median OS of 52.2 months. Conclusion: Long-term survival is possible in patients managed with ICI ± brain-directed treatment. This study did not identify a clear treatment sequence of choice. MDT assessment at diagnosis and each progression is recommended to ensure favorable outcomes.